Psychological Disorders

(Read: Abnormal Psychology An Integrative Approach, 8E)

  • Psychological disorders are behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment (DSM, 2015)
  • Defining a psychological disorder requires scientific study from different types of mental health professionals 
  • A diagnosis first begins with a description of current problems which are then understood as symptoms.
    • Symptoms help to segregated dysfunction from common distress
  • onset of disorders can be acute or chronic
    • acute onset is sudden and intense existence of symptoms associated with a disorder
    • chronic onset is a long drawn, not very intense but harmful existence of symptoms associated with a disorder

(Study Tip: Knowing one part of the two types of onset will help you remember the other one:
For the difference between acute and chronic, think of it as a-cute: as sudden and intense, similar to how you feel when you see a cute baby but in this case it’s for existence of symptoms of a disorder)

  • Causation
    • Historically most disorders have existed irrespective of time or culture
    • However, the reasons for the behaviour vary 
  • 3 traditions existed in explaining psychological disorders
    • Supernatural: belief that paranormal activities were responsible for psychological disorders
    • Biological: belief that psychological disorders are an outcome of dysfunctional bodily systems
      • Not in homeostasis
      • Humoral theory claimed that optimum functioning was dependent on an individual having two much or too little of four key bodily fluids (humors)
        • Blood, phlegm, black bile, yellow bile
      • General paresis (syphilis) and the biological link with madness
    • Psychological: present understanding of psychological disorders
      • Patients should be treated with respect as one would any other patient in a normal environment
        • Major proponents:
        • Philippe Pinel, Jean-Baptiste Pussin, Benjamin Rush, Dorothea Dix – mental hygiene movement
  • Psychoanalytic Theory conceptualization (Read: Personality Psychology)
    • Unconscious repressed anxiety causing memories lead to psychological disorders
      • Overuse of defensive mechanisms
      • Defense mechanisms are attempts made by the ego to manage the anxiety created by the conflict of id and superego
  • Humanistic Theory: the belief that psychological disorders are a result of lack of positivity in the clients life and lack of understanding from their immediate environment
    • Intrinsic human goodness
    • Striving for self-actualization
      • Person-centered therapy: Carl Rogers
      • Hierarchy of Needs: Abraham Maslow
  • The Behavioral Model (Read: Personality Psychology
    • Abnormal behaviour is a result of learnt behaviour either by classical conditioning, operant conditioning, or social learning theory
    • Classical conditioning: Ivan Pavlov
    • Operant Conditioning: B. F. Skinner
    • Social learning theory: Alfred Bandura
  • The Scientific Method and an Integrative Approach: understand abnormal behaviour from an eclectic point of view where many biological, psychological, social factors affect the individual resulting in maladaptive behaviour
  • The Clinical Interview is the main source of getting information from the client. It includes asking them about the present situation, past behaviour, history of the issues presented, family history, and a mental status exam
  • Mental status exam is the attempt to see the current disposition of the client. It is assessed by the following aspects:
    • Appearance and behavior
    • Thought processes
    • Mood and affect
    • Intellectual functioning
    • Sensorium
  • (Study Tip:  ATM-IS)
  • Diagnostic classification is important as it helps classifying the varied behaviours into specific parts
    • It is essential for all sciences
  • Idiographic strategy is the method of classifying based on extreme or unique aspects of individual’s personality, and culture
  • (Study Tip: idio for idiots who are unique or not common)
  • Nomothetic strategy is the method of classifying based on identifying a disorder and its patterns
  • Terminology of classification systems
    • Taxonomy is the scientific term for classification
    • Nosology is the taxonomy used for psychological or medical phenomena
    • Nomenclature are the labels attributed to the nosological labels (e.g., “mood disorder” “anxiety disorders”)
  • Classification approaches
    • Classical (or pure) categorical approach creating categories as rigid and unchanging categories
    • Dimensional approach look to create categories along a range of behaviour 
    • Prototypical approach is a combination of the two where labels are given but along a continuum 
  • Diagnostic and Statistical Manual of Mental Disorders (DSM) (Read: (DSM-5: A Comprehensive Overview)
    • Updated every 10-20 years
    • Current edition (released May 2013): DSM-5
    • Previous edition called DSM-IV-TR
  • International Classification of Diseases (ICD-10)
    • By the World Health Organization (WHO)
  • Problems with classification
    • Creates stigma and labels
    • Labels usually have negative connotations and may make patients less likely to seek treatment

Anxiety Disorder

  • Anxiety refers to a general feeling of apprehension about possible dangers which is different from a disorder.
  • Anxiety disorders are a group of disorders that include disorders that share features of excessive fear and anxiety and related behavioral disturbances.
  • The anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation.

Types

Specific Phobia

  • The term phobia refers to excessive fear of a specific object, circumstance, or situation.
    • A specific phobia is a strong, persisting fear of an object or situation.

Social anxiety disorder (Social phobia)

  • Persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
  • Persons with a social anxiety disorder are fearful of embarrassing themselves in social situations (i.e., social gatherings, oral presentations, meeting new people).
  • They may have specific fears about performing specific activities such as eating or speaking in front of others, or they may experience a vague, nonspecific fear of “embarrassing oneself”.

Panic disorder

  • Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

Generalized Anxiety Disorder

  • It involves anxiety & worries about many different aspects of life (including minor events) & it becomes chronic, excessive & unreasonable
  • People with GAD live in a relatively future-oriented mood state of anxious apprehension, chronic tension, worry & diffuse uneasiness.
  • They show marked vigilance for possible signs of threat in the environment and frequently engage in subtle avoidance activities such as procrastination, checking, or calling a loved one frequently to see if he or she is safe.
  • Their anxious apprehension makes them ready to deal with upcoming negative events

Obsessive Compulsive Disorder

  • OCD is characterized by the presence of obsessions and compulsions.
  • Obsessionsare recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas
  • Compulsionsare repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
    • Obsessive thoughts are from within/internal the person rather than from outside/external

Somatic symptom disorders

  • The prominence of somatic (bodily) symptoms associated with significant distress and impairment.
  • People with this disorder are commonly encountered in primary care and other medical settings but are less commonly encountered in psychiatric and other mental health settings.

Primary Somatic Symptom Disorders

  • Somatic symptom disorder. Formerly called somatization disorder, this chronic condition is characterized by unexplained physical symptoms. It is found almost exclusively in women
  • Somatic symptom disorder, with predominant pain. The pain in question has no apparent physical or physiological basis, or it far exceeds the usual expectations, given the patient’s actual physical condition.
  • Conversion disorder (functional neurological symptom disorder). These patients complain of isolated symptoms that seem to have no physical cause.
  • Illness anxiety disorder. Formerly called hypochondriasis, this is a disorder in which physically healthy people have an unfounded fear of a serious, often life-threatening illness such as cancer or heart disease—but little in the way of somatic symptoms.

Dissociative disorders

  • The critical component is a disturbance in functioning of consciousness, memory, identity, or perception of the environment.
    • The disturbance may be sudden or gradual transient or chronic.

Dissociative amnesia

  • An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting

Dissociative Fugue

  • Sometimes, an individual may go through an amnestic state where they may forget some or all aspects of their past and run away from their home. This is called as dissociative fugue.
    • After the amnestic state is over the individual may be confused about their personal identity

Depersonalization/Derealization disorder

  • Patients experience themselves as strange or unreal in some way.
    • They feel detached from their surroundings as if someone else is ‘in control’ or as if they are living in a dream or moving in slow motion.
    • The individual remains in touch with reality, but the symptoms may be persistent, recurrent & seriously impair functioning.

Mood disorders = gross deviations in mood

  • Mood Disorders:  A group of psychological disorders characterised by disruption of mood for longer periods of time that causes clinically significant impairment and distress. The two basic symptoms patterns in mood disorders are depression and mania, however, mixed states are also possible.
  • Depressed mood: sadness of mood or loss of interest and/or pleasure (Anhedonia) in almost all activities (i.e. pervasive sadness), which is present throughout the day (persistent sadness).
  • Manic mood is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1 week. The elevated mood is euphoric and often infectious and can even cause a countertransferential denial of illness by an inexperienced clinician.
  • Bipolar disorder occurs when period of depression are accompanied by periods of mania (Bipolar 1) or hypomania (bipolar 2)

Schizophrenia is a pervasive type of psychosis characterized by disturbed thought, emotion, and behavior.

Symptoms of Schizophrenia

  • “Positive” symptoms:
    • Active manifestations of abnormal behavior
    • Distortions or exaggerations of normal behavior
  • “Negative” symptoms:
    • Absence of normal behavior
  • “Disorganized” symptoms:
    • Erratic speech, emotions and behavior
    • Schizophrenia: The “Positive” Symptom Cluster
  • Delusions (disorder of thought content): false firm fixed belief that is held despite clear contradictory evidence and is not in keeping with the person’s socio-cultural & educational background. Types of delusions common in schizophrenia are:
  • Delusions of persecution: belief of being persecuted against. E.g. people are against me.
  • Delusions of reference: being referred to by others. E.g. people are talking about me.
  • Delusions of grandeur: exaggerated sense of self-importance. E.g. I am God almighty.
  • Delusions of control: belief of being controlled by an external force known or unknown. E.g. my neighbor is controlling me. 
  • Somatic(or hypochondriacal) delusions: E.g. there are insects crawling in my scalp.
  • Hallucinations are sensory experiences of events without environmental input
    • Hallucinations are most common for audition and sight but can involve all senses (e.g., tasting something when not eating, having skin sensations when not being touched)
  • Schizophrenia: The “Negative” Symptom Cluster
    • Absence or insufficiency of normal behavior
    • Spectrum of negative symptoms
      • Avolition (or apathy) – lack of initiation and persistence
      • Alogia – relative absence of speech
      • Anhedonia – lack of pleasure, or indifference
      • Affective flattening – little expressed emotion
  • Schizophrenia: The “Disorganized” Symptom Cluster
  • Goal directed activity is almost universally disrupted.

Impairment occurs in the areas of work, social relations, self-care.

  • Grimacing, strange facial expressions.
  • Gesture repeatedly using peculiar of complex finger, hand or arm movements; stereotypical behaviour.
  • Decreased self-care, poor grooming, silly dressing sense.
  • Catatonia: extreme behavioural disturbances.
  • May be considered a psychotic spectrum disorder in its own right or, when occurring in the presence of schizophrenia, a symptom of schizophrenia
  • Disorganised speech:
    • Cognitive slippage – illogical and incoherent speech
    • Tangentiality – “going off on a tangent”
    • Loose associations – conversation in unrelated directions
    • Incoherence: speech does not make sense to the listener. Although patient makes repeated references to central ideas, the images or fragments of thought are not connected.
    • Neologisms: new word formation and usage. These are meaningless to the listener. E.g. “prestigitis”. 
    • Word approximation: old words used in a new and unconventional way. E.g. my foodvessel is full.
    • Derailment: (loose associations) ideas slip off the topic’s track on to another which is obliquely related or unrelated. E.g. the nest day I’ll be going out you know, I took control. I put bleach on my hair in California.
    • Word salad: speech that is unintelligible as the manner in which words are strung together results in incoherent gibberish. E.g. why do people comb their hair? Ans: because it makes a twirl in life. Help the hair get elephant.  I love electrons, why not.
    • Poverty of content: amount of speech is adequate, but, it conveys little information because it is vague, overly abstract, repetitive, or stereotyped.
    • Perserveration: words and ideas are persistently repeated. E.g. it’s great to study in Delhi Delhi Delhi.
    • Echolalia: Echoing of another’s speech (words, sentences) that may be committed only once or may be continuous in repetition.
    • Blocking: an abrupt thought in the train of thought; the individual may or may not be able to continue the idea

Types

  • Paranoid:
    • History of increasing suspiciousness & severe difficulties in interpersonal relationships.
  • Disorganised (hebephrenic):
    • Characterised by disorganised speech, disorganised behaviour, flat or inappropriate affect.
  • Catatonic:
    • Immobile body or stupor.
    • Excessive motor activity that is purposeless & unrelated to outside stimuli
  • Undifferentiated:
    • It’s like a wastebasket category: Delusions, hallucinations, disordered thoughts & bizzare behaviour are present but symptoms don’t fall into one of the other types due to mixed symptom picture.
  • Residual:
    • absence of prominent delusions, hallucinations, disorganised speech & grossly disorganised or catatonic behaviour

Attention Deficit/Hyperactivity Disorder

  • ADHD is a neuropsychiatric condition which affects preschoolers, children, adolescents and adults. It is characterized by a pattern of diminished sustained attention and increased impulsivity or hyperactivity.
  • Infants with ADHD are active in the crib, sleep little, and cry a great deal.
  • School children may attack a test rapidly, but may answer only the first two questions. They may be unable to wait to be called on in school and may respond before everyone else. At home, they cannot be put off for even a minute. Impulsiveness and an inability to delay gratification are characteristic. Children with ADHD are often susceptible to accidents.
  • Characteristics:
  • Hyperactivity
  • Attention deficit (short attention span, distractibility, perseveration, failure to finish tasks, inattention, poor concentration)
  • Impulsivity (action before thought, abrupt shifts in activity, lack of organization, jumping up in class)
  • Memory and thinking deficits
  • SLD
  • Speech and hearing deficits
  • Perceptual motor impairment
  • Emotional lability
  • Developmental coordination disorder
  • Behavioural symptoms of aggression and defiance
  • School difficulties
  • Co-morbid communication disorders

Autism spectrum disorders

  • Main characteristic: Failure to develop age-appropriate social relationships
    • Trouble initiating and maintaining relationships
    • Autistic children do not show any need for affection or contact with anyone and they do not seem to know or care who their parents are.
    • The inability to respond to others is due to a lack of social understanding-a deficit in the ability to attend to social cues from others.
  • Mind Blindness: inability to take the attitude of others or to see things as others do.

Eating Disorders

  • Anorexia Nervosa: Overview and Defining Features
    • Extreme weight loss – hallmark of anorexia
      • Restriction of calorie intake below energy requirements (Sometimes defined as 15% below expected weight)
      • Intense fear of weight gain
      • Often begins with dieting
  • Bulimia Nervosa: Overview and Defining Features
    • Hallmark of bulimia nervosa and binge eating disorder is binge eating
      • Eating excess amounts of food in a distinct period of time
      • Eating is seemingly uncontrollable
      • Associated with guilt, shame or regret
      • May hide behavior from family members
      • Foods consumed are often high in sugar, fat or carbohydrates
    • Compensatory behaviors – designed to “make up for” binge eating
      • Most common: Purging  (Vomiting)
        • Most common purging method: Self-induced vomiting
        • May also include use of diuretics or laxatives

Substance-Related and Addictive Disorders

  • Substance use refers to intake of moderate amounts of a substance which doesn’t day-to-day functioning
  •  Substance intoxication refers to physiological reaction (high/perceptual changes) to the consumption of a substance (e.g., being drunk)
  • Substance abuse refers to the intake of a substance in a way that is dangerous or causes substantial impairment in many areas of functioning (e.g., affecting job or relationships)
  • Substance dependence is defined in two manners:
    • Increase in tolerance followed by withdrawal
    • Or drug-seeking behavior (e.g., spending too much money on substance)
  • Tolerance is defined as the need of more of a substance to continue to feel the same effect as was previously felt with less amounts of that substance.
  • Withdrawal refers to negative/unwanted physiological reactions to the absence of substance or discontinuation after regular use.
  • Five Main Categories of Substances
    • Depressants- Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)
    • Stimulants- Increase alertness and elevate mood (e.g., cocaine, nicotine)
    • Opiates- Produce analgesia and euphoria (e.g., heroin, morphine, codeine)
    • Hallucinogens- Alter sensory perception (e.g., marijuana, LSD)
    • Other drugs of abuse- Include inhalants, anabolic steroids, medications

Causes

  • Genetic Contributions to Psychological disorders
  • Nature of genes
    • Deoxyribonucleic acid (DNA) – the double helix
    • 46 chromosomes in 23 pairs
    • Dominant vs. recessive genes
    • Determine parts of physical and mental characteristics
      • Phenotype vs. genotype
    • Development and behavior is almost always polygenetic
      • Rare exceptions: single-gene determinants (e.g., Huntington’s disease, phenylketonuria)
    • Generally speaking, genes account for less than 50% of variations in psychological disorders
  • The Interaction of Genetic and Environmental Effects
    • Diathesis-stress model: Disorders are the result of underlying risk factors combining with life stressors that cause a disorder to emerge
    • Outcomes are a result of interactions between genetic vulnerabilities and experience
    • Examples: depression, impulsivity
    • Genetics may make people more likely to seek out certain environments, thus affecting their experiences
  • The Contributions of Behavioral and Cognitive Science
    • Conditioning and cognitive processes
      • Early research on classical conditioning: Simple associations are learned between two things that tend to occur together
      • Later research indicated that it is not always that simple – influenced by higher-order cognitive processes
    • Other types of learning
      • Respondent and operant learning
        • Learn to repeat behaviors followed by desirable consequences and decrease behaviors followed by undesirable consequences
    • Other types of learning
      • Learned helplessness
        • First demonstrated in animal models, but may contribute to the maintenance of depression
        • Rats given occasional shocks
          • Gave up trying to control the shocks if attempts were ineffective (i.e., “learned” not to bother trying)
    • Social learning
      • Based on research of Albert Bandura
      • Modeling and observational learning: Learn to copy the behaviors that seem to turn out well for other people
    • Prepared learning
      • It is easier to learn associations that would have been helpful to our ancestors
      • Example: Easier to acquire a fear of spiders because it was adaptive for our ancestors to fear (possibly poisonous) spiders
  • Cultural, Social, and Interpersonal Factors in Psychological Disorders
  • Cultural factors- Influence the form and expression of behavior
    • Example: Children raised to be autonomous are less fearful
    • Example: Culturally-bound fears
  • Gender effects
    • Men and women may differ in emotional experience and expression
    • Examples:
      • 90% of insect phobia sufferers are female
      • Most bulimia sufferers are female
      • Alcohol use disorders are more common in men
    • May be related to gender roles: Certain ways of coping with emotion are more acceptable for men or women
      • Cultural, Social, and Interpersonal Factors in psychological disorders
  • Effect of social support
    • Low social support related to mortality, disease, and psychological disorders
    • Frequency and quality important
    • Social support especially important in the elderly
  • Social Stigma of psychological disorders
    • May limit the degree to which people express mental health problems
      • E.g., concealing feelings of depression > unable to receive support from friends
    • May discourage treatment seeking

Next chapter: Social Psychology